Special Operations Forces Medical Handbook
8-11
- Prepare the area.
a. Free from electrical interference.
b. Comfortable and private for the patient.
c. Convenient for the person obtaining the EKG.
d. Free from distractions (noise, traffic).
- Prepare the patient.
a. Explain the procedure to the patient and answer any questions.
NOTE: Many patients will be apprehensive about being connected to an electrical instrument.
Reassure the patient that there is no danger and they will feel no pain.
b. Ask (or assist) the patient to remove all clothing from the waist up. Provide a chest drape for
female patients.
c. Ask (or assist) the patient to lie supine on the bed or examination table.
NOTE: Patients with respiratory problems may be unable to tolerate the supine position. If
necessary, elevate the head of the bed to 45°.
CAUTION: When necessary, ensure the patient’s IV tubing and/or urinary catheter tubing is handled
with care and positioned properly to avoid discomfort to the patient.
d. Ensure the patient’s body is not in contact with the bed frame or any metal objects and that
all limbs are firmly supported.
e. Ask the patient to relax and breathe normally throughout the procedure.
- Apply the chest electrodes.
a. Clean the sites for electrode placement by rubbing with an alcohol prep pad to remove dead skin,
oils, and traces of soap or dirt.
b. Apply a small amount of EKG paste to the sites.
c. Attach the electrodes, being careful to place them over the intercostal spaces and not directly over
the ribs. Lead II (bipolar) is the most commonly used lead.
(1) Attach the negative electrode (white) to the right arm, right shoulder, or upper right anterior
chest wall.
NOTE: Place the electrodes on “meaty” places NOT directly over bone because bone is not a good
conductor of electricity.
(2) Attach the positive electrode (red) to the left leg, left thigh, or lower left anterior chest wall at the
intersection of the fourth intercostal space and the mid-clavicular line.
NOTE: The latter is least preferred since it may interfere with the defibrillator paddles if a
dysrhythmia should occur.
(3) Attach the electrically neutral electrode (black) to the left arm or right anterior chest.
d. Ensure these 3 leads form a triangle around the heart referred to as Einthoven’s Triangle.
Placement of Lead-II electrodes.
e. Obtain a readable EKG strip.
(1) Interpret the current flow for Lead II.
(a) When an electrical current flows toward the positive electrode, a positive (upward) deflection
is recorded on the EKG.
(b) When an electrical current flows away from the positive electrode, a negative (downward)
deflection is recorded on the EKG.
(c) The absence of any electrical impulse, results in the recording of an isoelectric line (flat
line).
- Interpret whether the rhythm strip is normal or abnormal.
a. Step 1: Determine whether the rate is normal. Compare to pulse found on patient.
(1) Six-second method.
(a) Count the number of R-waves in a 6-second interval by noting two 3-second marks at the
top of the EKG paper.
(b) Multiply the number of R-waves within the 6-second strip by 10, which will give the heart
rate per minute.
(2) Triplicate method
(a) Locate two R-waves that fall on dark lines on the graph paper.
(b) Assign numbers corresponding to the heart rate to successive dark lines starting with the
